Editorial: Tennessee needs health exchange

Tennessee needs to push forward and establish its own state-run health exchange as part of Obamacare.

The newly elected state legislature, the most Republican-dominated legislature in the state's history, likely will need the Heimlich maneuver to get the word Obamacare unstuck from its craw. But legislators need to look for some way to do just that.

President Barack Obama has been re-elected, along with a majority Democratic U.S. Senate, so there is no chance that the Affordable Care Act will be repealed. In addition, the U.S. Supreme Court has confirmed the constitutionality of the legislation. Against this backdrop, the die-hard opposition to Obamacare seems futile.

Still, many Republican governors, including Tennessee's Bill Haslam, are being pressured not to agree to set up statewide health exchange networks to manage the details of the Affordable Care Act. It's a desperate last gasp of opposition to a law that is on the books, is moving forward, and will become much more popular as its many benefits roll out.

If a state chooses not to set up its own health exchange, the law allows the federal government to come into that state and set up an exchange without state involvement. That will make the case that the federal government is intruding in state affairs, but it means that states like Tennessee will have missed an opportunity to maintain local control over the exchange. And Tennessee faces unique challenges in health care that are best addressed by Tennesseans.

For example, state exchanges will decide the pace at which new patients are allowed to sign up for new health insurance. With more than 800,000 Tennessee residents currently without health insurance, the pace at which these residents are added to the system will be an important issue when it comes to managing costs and facilities utilization.

Also, state exchanges will decide what essential health services must be offered by the state's insurance companies. And, the state exchanges will be charged with merging existing health systems, like TennCare, into the new federal guidelines.

All of this is important, local work. Setting up a state health exchange is clearly the best option for Tennessee if the goals are to maintain maximum local control of the Affordable Care Act and make sure that Tennessee residents are getting the best care they can under the new law.

Haslam has a good record when it comes to watching out for Tennessee. He needs support from his own Republican legislature in moving forward on establishing a Tennessee health exchange.